Provider Demographics
NPI:1750332276
Name:WOOD, WALTER S (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:S
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9824 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1150
Mailing Address - Country:US
Mailing Address - Phone:402-553-5099
Mailing Address - Fax:
Practice Address - Street 1:810 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-2182
Practice Address - Fax:402-426-1190
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21916207Q00000X
IA34081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
35466OtherBCBS
IA6238063Medicaid
IA6238063Medicaid
35466OtherBCBS